Impact of IUCD Use on Vaginal Microbiota and Antibiotic Resistance: A Comparative Study Among Iraqi Women

Abstract

Background: Bacterial vaginosis (BV) is a prevalent vaginal infection affecting millions of women worldwide, often associated with an imbalance in vaginal microbiota. The use of intrauterine contraceptive devices (IUCDs) has been linked to alterations in vaginal flora, increasing the risk of infections. However, data on the bacterial composition and antibiotic susceptibility patterns in IUCD users compared to non-users remain limited, particularly in Iraqi women. Objectives: This study aims to assess the prevalence of vaginal bacterial colonization in IUCD users versus non-IUCD users and determine the antibiotic resistance patterns among Gram-negative bacterial isolates. Additionally, the study evaluates vaginal pH variation Methodology: The study was conducted in a private gynecology clinic in Dhi Qar Governorate, Iraq, from November 2022 to June 2024. A total of 170 women (99 IUCD users and 71 non-IUCD users) were enrolled. High vaginal swabs (HVS) were collected and analyzed using the VITEK® 2 compact system (bioMérieux, France) to identify bacterial species and assess antimicrobial susceptibility. Vaginal pH was measured using litmus paper. Results: The vaginal pH range (3–6) showed no significant difference (P > 0.05) between IUCD and non-IUCD users. However, IUCD users had a significantly higher bacterial load. Escherichia coli was the most common Gram-negative isolate in both groups. Conclusion: This study underscores a higher prevalence of bacterial colonization and antimicrobial resistance in IUCD users, particularly against β-lactams and fluoroquinolones. Culture-based antibiotic therapy is recommended to prevent treatment failure in vaginal infections. Further research is needed to evaluate the long-term effects of IUCD use on bacterial biofilm formation and antibiotic resistance evolution.